Hearing loss is an incredibly debilitating, life-altering disorder. Noise, age, and ototoxic drugs such as antibiotics and cancer drugs put stress on the cochlea, leading to hearing loss. According to the World Health Organization (WHO), by 2050, over 700 million people worldwide will be affected by hearing loss [
1]. Unfortunately, no effective and reliable method for monitoring and detecting cochlear stress exists. Most importantly, it is impossible to identify cochlear stress before irreversible tissue damage and hearing loss have already occurred. Therefore, exploring the potential of cochlear stress biomarkers is an area of interest for researchers and clinicians. It may provide valuable insights into the pathology of cochlear damage and inform the development of more effective diagnostic and therapeutic interventions.
Mammalian hearing relies on outer hair cells (OHCs) electromotility to achieve high sensitivity and sharp frequency selectivity. In 2000, we identified
prestin, a member of the anion transport family called SLC26A5, as the molecular basis for OHC’s electromotility [
2]. By changing its conformation between short and extended states, Prestin subserves OHC motility when switching between depolarized and hyperpolarized conditions [
3,
4,
5,
6,
7,
8]. Several lines of evidence showed that the lateral membrane of OHCs is primarily occupied by Prestin. OHCs from
prestin-knockout (KO) mice lose their somatic electromotility, resulting in 50 dB hearing loss in
prestin-KO mice [
9,
10,
11]. OHCs without Prestin proteins are also 40% shorter than the WT-OHCs [
12]. Since OHCs are highly vulnerable to various insults, OHC-specific proteins are considered an excellent choice for revealing biomarkers that are useful in detecting cochlear stress and damage. By using a sandwich enzyme-linked immunosorbent assay (ELISA), Prestin was detected in the bloodstream of humans [
13,
14,
15], rats [
16,
17], guinea pigs [
18,
19], and mice [
20]. Several reports suggested that Prestin in the bloodstream could be used as a biomarker for hearing loss such as idiopathic sudden sensorineural hearing loss [
13,
14,
15,
21,
22], noise-induced hearing loss [
16,
17,
23,
24,
25], sensory hearing loss [
26,
27,
28], age-related hearing loss [
29], ototoxic regents induced hearing loss, such as HPβCD [
30] and cisplatin [
18,
19,
20,
31], and also hearing loss observed in various diseases like Meniere’s Disease and Vestibular Migraine [
32], COVID-19 [
33], lead poison [
34], and even surgical related damage [
21]. However, the data reported in several studies lack proper negative controls and show inconsistency [
13,
14]. Furthermore, Prestin is also reported to be present in the myocardium of hearts [
35], raising doubts about whether the Prestin detected in the bloodstream is solely derived from OHCs. To investigate whether Prestin is a serological biomarker for cochlear damage or stress, cochlear homogenates from WT mice and
prestin-KO mice [
9] were used as positive and negative controls, respectively. These mice were also exposed to various ototoxic stimulations to cause cochlear stress, including noise exposure and ototoxic chemical treatment. HPβCD rapidly kills OHCs [
36,
37] and releases Prestin into extracellular space. The serums and cochleae from WT and
prestin-KO mice were collected at different time points after HPβCD injection or noise exposure. Prestin concentrations in the bloodstream and cochleae were measured using mouse Prestin ELISA kits purchased from three different companies, and cochleae were also used for anatomic analysis. Our collected data suggest that Prestin from OHCs is not a sensitive and reliable serological biomarker for detecting cochlear damage.